Samrakshan Program and Pathophysiology of Pre-eclampsia

MedPiper Technologies and JournoMed had conducted a World Pre-eclampsia week Webinar Series in Association with National IRIA Preventive Radiology and Samrakshan Committees. On Day 1, the speakers, Dr. Rijo Mathew, Dr. Lalit Sharma and Dr. Gulab Chhajer discussed the topics of Samrakshan Program and Pathophysiology of Pre-eclampsia. The Day 1 Event was held on 23rd May 2022, Monday.

What is Samrakshan?

Dr. Rijo Mathew and Dr Lalit Sharma spoke about the Samrakshan Program. It is a National Program of IRIA that aims to reduce morbidity and mortality rates that occur during pregnancy and childbirth in India. Statistics show that low birth weight babies, stillbirth rates, perinatal mortality and the neonatal mortality, infant mortality cases, child mortality cases are more prevalent in India. Neonatal mortality rates were higher in the states of Rajasthan, Uttar Pradesh, Madhya Pradesh and Orissa. In India, 28 million pregnancies occur every year, out of which 26 million live births, 67000 maternal death cases, 1 million neonatal deaths and 7.5 lakhs perinatal deaths are seen. Infant mortality rate is 42 out of 1000 cases.

The Samrakshan team was initiated by an eminent group of Radiologists from IRIA. Samrakshan focuses more on maternal mortality and birth related complications. Dr. Rijo states that Radiologists’ main focus must be on figuring out structural integrity, foetal growth and congenital abnormalities. The stakeholders involved in foetal care and pregnancy are obstetricians, gynaecologists, neonatologists, radiologists etc. Radiologists are the prominent stakeholders who take care of maternal health during the time of pregnancy.  

How does Samrakshan Aim to help Pregnant Women in India?

Samrakshan provides a targeted approach to mothers to modify the risks involved in pregnancy in a relatively short period. This program launched a 7 star program to identify prematurity, foetal growth restriction and pre-eclampsia for better pregnancy outcomes. The major concentration of this Program is in Tier 2 cities so that rural and uneducated women can gain awareness and obtain benefits by following the Samrakshan Protocol.

Preventive Radiology is one such emerging branch of Radiology that came into the limelight. This branch along with all the advanced technologies are being implemented by most Radiologists across the globe to eradicate morbidity and mortality cases among pregnant women and neonates. The major goal of Samrakshan is to work for the welfare of pregnant women and provide them proper care during pregnancy. 

Pathophysiology of Pre-eclampsia

Dr. Gulab Chhajer, MD Radiology, spoke about the Pathophysiology of Pre-eclampsia (PE) and how it affects both mother and child. Preeclampsia is a pregnancy specific disorder that usually occurs during the 20th week of gestation accompanied by proteinuria, edema, impaired liver function and cerebral visual symptoms. It affects 3-8% pregnant women worldwide.

Major contributing factors for pre-eclampsia are gestational age, premature birth and intrauterine restriction. Understanding uteroplacental anatomy might give a clear idea regarding foetus formation, its growth pattern in the uteroplacental chamber and explains why pre-eclampsia occurs.

How does pre-eclampsia occur?

During placentation, implantation occurs at an early stage of 6-12 weeks, followed by trophoblast invasion initiation. Uteroplacental perfusion is observed between 11-14 weeks and trophoblast invasion concludes between 19-20 weeks of foetal growth. In pre-eclampsia, a defective foetal implantation might occur which results in pregnancy complications and foetal growth restrictions (FGR). This might hinder healthy growth of the foetus. So, it is advisable for women to be careful during pregnancy. Knowing about Placental remodeling and why Uterine Pulsatility Index continuously drops during pregnancy might give further information regarding PE and FGR. 

At early onset PE, incomplete transformation of spiral arteries takes place which results in hypoperfusion of placenta. This leads to inadequate supply of nutrients to the foetus. Defective placental implantation causes oxidative stress and can result in preterm labour, placental abruption and miscarriage. 

What can be done regarding pre-eclampsia?

Many woman do not know of these conditions that causes miscarriage. Hence, an awareness is required regarding prenatal, perinatal and postnatal pregnancy care which can reduce mortality rates to a major extent.

Many doctors and radiologists must be aware of the following regarding pre-eclampsia:

• molecular basis of pre-eclampsia
• pre-eclampsia types i.e. Early onset PE and late onset PE,
• the risk factors involved in the pre-eclampsia,
• micro placental defects seen in the histopathological patient reports,
• the role and level of biomarkers that reflect the pathophysiology of defective placentation,
• maternal outcomes associated with pre-eclampsia,
• foetal outcomes in pre-eclampsia

Studies to evaluate maternal and foetal outcome in pregnant women with pre-eclampsia show that maternal morbidities were common in patients with the severe form of this condition. Pre-eclampsia complications of renal failure, placental abruption and eclampsia are observed in most patients. 

This serious issue can be resolved with a single aspirin dosage which serves as a game changer. It helps in reducing pre-eclampsia conditions in most cases. A 150 mg dosage of Aspirin must be prescribed by the radiologists to stop the foetal morbidity and mortality at very early stages. 

Pre-eclampsia can be easily managed with medication, whereas severe conditions might lead to the patient being hospitalized. Labour is induced if the conditions are not easily managed with medications. Usually antihypertensives are prescribed by radiologists or the concerned physicians to reduce the high blood pressure in pregnant women.